Dear Policymaker,

Letter to Policymakers: Strengthening the Availability of Home Health Care

I am writing on behalf of the Center for Home Health Medicare Advocacy to address a growing and urgent problem in the American healthcare system: the declining availability of Medicare-covered home health services for the people who need them most.

Home health is not an optional benefit. It is the infrastructure that allows millions of older adults, disabled individuals, and medically fragile Americans to remain safely in their homes — the setting where outcomes are best, costs are lowest, and dignity is preserved. Yet across the country, agencies are withdrawing, limiting, or refusing services for patients who meet Medicare’s criteria and whose survival depends on continuity of care.

This is not a theoretical issue. It is happening every day.

I can speak to this both as an advocate and as one of the many Americans who depend on home health to remain safely at home. I live alone in a rural community where there is no alternative facility, no backup system, and no informal care network to fill the gaps. When home health support is withdrawn, the consequences are immediate. My situation is not unique — it is simply visible.

What happens to me is what happens to thousands of rural elders and chronically ill patients across the country:
the system fails not because the need is unclear, but because the structure does not support the care.

The good news is that policymakers can take concrete steps to strengthen home health availability. The solutions are practical, evidence-based, and aligned with both fiscal responsibility and patient well-being.

What Policymakers Can Do

1. Reinforce Medicare’s Existing Standards for Eligibility and Continuity
   Medicare already allows coverage for chronic, recurring, and unstable conditions that require skilled oversight.
   The problem is not the law — it is inconsistent interpretation and enforcement.

Policymakers can:

Direct CMS to issue clearer guidance emphasizing that chronic conditions do qualify.

Strengthen oversight to ensure agencies do not discharge patients prematurely.

Require documentation of clinical rationale when agencies decline or discontinue care.

This alone would prevent thousands of avoidable hospitalizations.

2. Address Workforce Shortages Through Targeted Incentives
   Home health agencies cannot provide care without nurses, therapists, and aides.
   Rural areas are hit hardest.

Policymakers can:

Create rural service incentives similar to those used in primary care.

Expand loan-forgiveness programs for home health clinicians.

Support training pipelines that prepare workers specifically for home-based care.

These measures are cost-effective and immediately impactful.

3. Adjust Reimbursement to Reflect the Real Cost of Chronic Care
   Current payment structures reward short-term, post-acute episodes rather than long-term stabilization.
   This misalignment pushes agencies to avoid chronic patients — even when they are fully eligible.

Policymakers can:

Modify the PDGM model to better support chronic and rural patients.

Provide add-on payments for high-need, high-risk individuals.

Ensure that agencies are not penalized for serving patients who require ongoing skilled oversight.

This is not an expansion of benefits — it is a correction of incentives.

4. Require Transparency When Agencies Decline Eligible Patients
   Right now, agencies can simply say “we don’t have capacity,” leaving patients with no recourse and no data for policymakers.

Policymakers can:

Require agencies to report when they decline eligible Medicare patients.

Track patterns by region, diagnosis, and staffing level.

Use this data to guide workforce and reimbursement reforms.

Without transparency, the problem remains invisible.

5. Support Home-Based Care as a Core Component of National Health Strategy
   Population-level research is unequivocal:
   People who remain at home live longer, avoid institutionalization, and cost the system far less.

Policymakers can:

Integrate home health into aging-in-place initiatives.

Fund pilot programs for chronic-care stabilization at home.

Recognize home health as essential infrastructure — not an afterthought.

This is both humane and fiscally responsible.

Why This Matters
My own experience — living alone in a rural town, dependent on home health for safety and stability — is simply one example of a national pattern. When home health fails, people are pushed toward crisis, hospitalization, or institutionalization not because their condition worsened, but because the system withdrew the care that keeps them stable.

Strengthening home health is not only the right thing to do; it is the economically rational choice.
It reduces hospitalizations, prevents nursing home placement, and supports the millions of Americans who want to remain safely in their homes.

The Center for Home Health Medicare Advocacy stands ready to assist with data, testimony, and policy development. We ask for your leadership in ensuring that home health remains available, accessible, and aligned with the needs of the people it is meant to serve.

Thank you for your attention to this critical issue.

Sincerely,

Charles Bear
Chair
Center for Home Health Medicare Advocacy